Healthcare Provider Details

I. General information

NPI: 1972612125
Provider Name (Legal Business Name): DAVID T VOLARICH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10199 WOODFIELD LN
SAINT LOUIS MO
63132-2922
US

IV. Provider business mailing address

10199 WOODFIELD LN
SAINT LOUIS MO
63132-2922
US

V. Phone/Fax

Practice location:
  • Phone: 314-993-6611
  • Fax: 314-993-6011
Mailing address:
  • Phone: 314-993-6611
  • Fax: 314-993-6011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberR2D83
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number34.002784
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: